[Marked mesenteric neurofibromatosis in neurofibromatosis 1].
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Adult↗
Biomedical subjects
A Bittinger
Publications and source records attributed to A Bittinger.
Silver staining nucleolar organizer region in prostate cytology.
Amongst males, the prevalence of prostate cancer is third in frequency with a rising incidence. As the population grows older, the number of latent cancer of the prostate increases. Therefore, diagnostic tools for an early detection of this malignancy are necessary. Silver staining of nucleolus organizer regions (AgNOR) is a new technique in tumour analysis. It is especially valuable as an addition to classical prostate cytology. A report on 90 cases of transrectal prostate aspiration biopsies is presented. 81 of these had a histological evaluation (biopsy gun) at the same time. The air-dried slides were stained according to Ploton et al. [10]. The AgNORs were counted and measured by means of an interactive image analysis system. Patients without malignancy were reliably classified as negative both by routine cytology as well as by AgNOR analysis. The sensitivity in routine tumor diagnosis was ca. 87%. In contrast, the AgNOR index revealed a sensitivity of 96% and a specificity of 97%. Thus, AgNOR staining improves differential diagnosis in inconclusive cases. Our data suggests that the inexpensive AgNOR analysis improves differentiation between carcinomatous and benign prostatic cells. It is a useful tool, in addition to routine prostatic cytology.
Biopsy↗
[Papillomatosis in a bile duct cyst in an adult].
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Ampulla of Vater↗
Nuclear morphometry of soft tissue tumors of fibrous origin.
In this study we investigated the diagnostic significance of a set of different morphometric nuclear parameters in the differential diagnosis of soft tissue tumors. Nuclear area, the standard deviation of the nuclear area, the shape factor and other parameters such as Feret's Diameter and Martin's Radii were assessed using a computer assisted image analyzer system. A statistically significant difference (p < 0.01) between benign and malignant tumors and tumor-like lesions could be confirmed for the nuclear area and the standard deviation of the nuclear area, with the significance level being lower (p = 0.5) for the latter parameter. The shape factor also discriminated between the examined groups. Reclassification of the assessed histological diagnosis was performed by linear discriminant analysis using all possible combinations of the different nuclear parameters. This procedure disclosed an increasing rate of correctly reclassified cases with rising number of parameters applied. We conclude that the assessment of nuclear parameters may be helpful in the correct diagnosis and differential diagnosis of soft tissue tumors and tumor-like lesions of fibrous origin.
Cell Nucleus↗
[Focal necrotising vasculitis of the testis. Testicular manifestations of immunologic diseases in differential diagnosis of testicular cancer].
We report on the case of a 31-year-old male patient with focal testicular vasculitis as the only clinical manifestation of endangiitis obliterans (Winiwarter-Buerger disease), who presented with acute scrotal pain and swelling suggestive of a testicular tumor. Doppler sonography revealed significantly increased vascularization at the borders of the lesion, which rather indicated a vascular process; however, the presence of solid areas meant that the possibility of testicular cancer could not be excluded. Left inguinal orchiectomy was performed. The surgical specimen revealed histological patterns compatible with endangiitis obliterans; Raynaud phenomenon was the only sign of systemic disease, and no other organs were found to be affected. Despite the high sensitivity and specificity of ultrasound/Doppler sonography, in the differential diagnosis of an unexplained testicular mass surgical exploration is still mandatory. The different types of focal vasculitis are described and discussed with reference to the literature.
Adult↗
Immunosuppressive treatment in autoreactive myocarditis--results from a controlled trial.
It is still a matter of controversy whether immunosuppressive therapy is beneficial in patients with acute myocarditis, although autoimmune mechanisms play an important role in the development of myocarditis and its sequelae, for example, in dilated heart muscle disease, particularly because it is postulated that in man immunosuppression may aggravate the viral cell damage that is proposed to trigger the myocarditis. We report the clinical (NYHA-class), haemodynamic (improvement of left ventricular ejection fraction, left ventricular end-diastolic volume index), histological (infiltrate, fibrosis, myocyte hypertrophy) and immunohistological (immunoglobulin and C3-binding) findings in a controlled study including 17 patients with active myocarditis or acute perimyocarditis who were treated with a combination of prednisone and azathioprine for 3 months. We compared them with 21 patients of comparable clinical and haemodynamic compromise who underwent conventional treatment. Follow-up examinations were performed after 3 months. There was significant improvement of ejection fraction and NYHA-classification under immunosuppressive treatment. Infiltrates were reduced significantly in the immunosuppressed patients group only. Binding of IgG and IgM in the endomyocardial biopsy was diminished slightly but not significantly by both regimens. Fibrosis and myocyte hypertrophy were augmented in both treatment arms. There was no difference with respect to prognosis: four patients died or underwent heart transplantation in the immunosuppressive treatment group compared to five conventionally treated patients.
Acute Disease↗
Pulmonary arteritis with pulmonary arterial thrombosis and recurrent endopulmonary embolization.
A 41-year-old woman underwent medical examination for superficial thrombophlebitis of both lower legs. Incidentally a chronic myelogenous leukemia was diagnosed and chemotherapeutically treated. Three weeks after the first attendance the patient again suffered superficial thrombophlebitides of all extremities. Clinically she exhibited symptoms of recurrent mild pulmonary embolization. Contrast venography revealed no signs of deep venous thrombosis of legs, pelvis, or cava inferior. Despite continuous full-dose intravenous heparin administration the patient died, with signs of fulminant pulmonary embolization. Surprisingly, necropsy revealed a complete thrombotic occlusion of the pulmonary arterial system caused by pulmonary arteritis with signs of recurrent pulmonary embolization from a parietal truncus pulmonalis thrombosis. In addition, an appositional growth of parietal thrombi central from peripheral arterial ramifications had occurred. Simultaneously, superficial thrombophlebitis of all extremities was observed without any additional signs of general vasculitis. There was no strong evidence for a causal relationship between the chronic myelogenous leukemia and pulmonary arteritis nor for any other underlying systemic disorder. Therefore we consider the pulmonary arteritis a possibly primary one. This very rare disease is discussed with respect to the literature.
Adult↗
Pulmonary arteritis with pulmonary arterial thrombosis and recurrent endopulmonary embolization.
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Adult↗
[In vivo and ex vivo expression of nucleolar proliferation-associated antigens (p120, B23) in the prostate].
Expression of two nucleolar antigens, p120 and B23, was studied in a prostatic carcinoma cell line (LNCaP) and in frozen and paraffin embedded tissue sections of 40 benign and malignant prostatic lesions. The percentage of p120 negative G0/G1 phase cells rose significantly during transition from exponential to plateau growth phase in vitro (from 9% to 32%). In contrast, B23 was equally expressed throughout different cell cycle and growth phases. Thus, nucleoli of almost all stromal and epithelial cells were stained by B23 in tissue sections. P120, however, selectively stained nucleoli of proliferating prostatic epithelium. Whereas 88% (13/15) of benign hyperplasia were p120 negative this was the case in only 24% (6/25) of carcinomas. Using microwave procedure both MoAbs reacted in paraffin sections, but the percentage of p120 negative cases doubled. A routine application to formalin fixed and paraffin embedded tissue cannot be recommended thus far.
Cell Cycle↗
[Urinary bladder nuclear cytology: results of karyometric investigations].
To assess the value of nuclear morphometry in the cytological diagnosis of urinary bladder carcinoma, washouts of the urinary bladder from 168 patients with histological established bladder cancer were studied. Morphometrical measurements were done on the nuclei of the exfoliated cells. This retrospective study showed that the nuclear parameter obtained by automated image analysis may be helpful in the differential diagnosis between neoplastic and non-neoplastic urinary bladder disease and correlate fairly with the classic histologic grading of malignancy in transitional cell carcinoma of the urinary bladder.
Cell Nucleus↗
[Atypical hyperplasia of the prostate: coincidence with invasive carcinoma. A study of 69 prostatectomy preparations].
In a series of 69 prostatectomy specimens, including 62 invasive carcinomas, we studied the prevalence of atypical hyperplasia of small acinar, large acinar and cribriform type, diagnosed according to the criteria of J. Kovi, 1989. The study was performed on serial whole sections of 5 mm thick slices. As a result, the association of atypical large acinar hyperplasia with small acinar or cribriform atypical hyperplasia was significantly increased in cases with coincidental carcinoma. Furthermore, atypical cribriform hyperplasia was almost exclusively found in cases with cribriform or solid type of invasive carcinoma.
Humans↗
[Food remnant embolism of the lung].
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Adenocarcinoma↗
[Sonographically guided fine-needle puncture of adrenal tumors].
Ultrasound-guided fine-needle aspiration biopsies were performed in 37 patients (23 women, 14 men; mean age 58 [47-81] years) out of 310 patients in whom an adrenal tumour had been diagnosed by ultrasound between 1985 and 1991. In 21 the tumour diameter was 2-4 cm, in 16 over 4 cm. In 36 patients (97%) the material was suitable for histological analysis. There were 15 metastases, 4 primary adrenal carcinomas and 17 adenomas. 20 of 27 with an underlying malignant tumour had a malignant adrenal tumour (one of the aspiration biopsies in these cases was false-negative), while in 7 the space-occupying lesion was found to be benign. There were no false-positive findings. Ultrasound-guided fine-needle biopsy thus proved to be a reliable and informative method in the diagnosis of adrenal tumours. It should be undertaken under appropriate indication to ascertain the benign or malignant nature of a suspected adrenal lesion.
Adrenal Gland Neoplasms↗
Morphometry of parenchymal and vascular alterations in ARDS after extracorporal carbon dioxide removal therapy (ECCO2-R-therapy).
The lungs of 12 patients suffering from ARDS treated by ECCO2-R-therapy were examined. The thickness of the interlobular septa, area portions of honeycombing, bleeding and lung parenchyma with diffuse alveolar damage were assessed by semi-automatic image analysis. Medial thickness of the pulmonary arteries with an external radius ranging between 40 microns and 150 microns was assessed planimetrically. The area portion of honeycombing ranged from 0% to 66% (average: 28.8%, standard deviation: 17.0%). The thickness of interlobular septa was increased with values between 74.0 microns and 195.5 microns (average: 140.4 microns, standard deviation: 41.7 microns; normal controls: 72.0 microns +/- 19.5 microns). Parenchymal and vascular changes were closely related: Average medial thickness rose from nearly normal values (4.9%) in cases with low area portions of honeycombing and bleeding to the double (11.1%) of normal values in cases with area portions of honeycombing and bleeding greater than 40%. We conclude that parenchymal changes due to shock and high inspiratory O2 concentration lead to changes of the pulmonary arterial hemodynamics which result in a quickly developing medial hypertrophy.
Adolescent↗
Paraurethral actinomycosis.
Actinomycosis of the genitourinary tract is rare. Herein we report a case of actinomycosis of the urethra following staged hypospadia repair. Pathophysiology and treatment options of this rare lesion are discussed.
Actinomycosis↗
[Chronic purulent, draining, indolent pancreatic head pancreatitis with extrahepatic cholestasis].
Over the period of two weeks a 19-year-old man developed gradually increasing painless jaundice with dark urine and light-coloured soft stools (6-7 times daily), as well as loss of appetite, nausea and nagging itch. Biochemical tests indicated marked cholestasis (alkaline phosphatase 800 U/l, gamma-GT 206 U/l). Abdominal ultrasound examination revealed high-grade stenosis of the distal choledochal duct caused by an enlargement of the head of the pancreas and computed tomography confirmed a tumour in this location. Endoscopic retrograde cholangiopancreatography demonstrated filiform stenosis of the major pancreatic duct and prepapillary stenosis of the choledochal duct. Several needle biopsies failed to establish a definitive diagnosis. A Whipple operation was performed: the stomach was preserved but about 40% of pancreatic tissue resected. Histologically there was chronic suppurative pancreatitis of the head of the pancreas. The patient was symptom-free 6 months after the operation. The case illustrates that it is not always possible in a painless pancreatic tumour to distinguish between pancreatitis and malignant tumour.
Adult↗
[Lipomatous hypertrophy of the atrial septum. Cardiac-induced syncope in hamartoma of the right heart atrium].
A previously well 40-year-old woman suddenly collapsed and had to be resuscitated by an emergency physician. Admitted to hospital she remained unconscious and needed artificial respiration. Diagnostic tests failed to find evidence for pulmonary embolism, myocardial infarction or myocarditis. ECG monitoring in the intensive care unit merely revealed occasional unifocal ventricular premature systoles. Echocardiography was within normal limits. She remained in coma without spontaneous respiration. Cranial computed tomography and serial electroencephalograms indicated brain death. Autopsy revealed lipomatous hypertrophy (hamartoma) of the atrial septum with extensive bleeding into it as the most likely cause of (unrecorded) malignant cardiac arrhythmias.
Adult↗
Prognostic significance of nucleolar organizing regions (NORs) in carcinomas of the sigmoid colon and rectum.
The prognostic significance of silver-binding nucleolar organizing regions (AgNORs) has been evaluated in tissue sections of biopsies taken from 70 primary adenocarcinomas of the colon sigmoid (n = 25) and rectum (n = 45) prior to their curative resection. A significant correlation between five-year survival rate and the mean AgNOR number per tumour cell (p less than 0.001) and the mean size of silver stained dots (p less than 0.05) was found according to the univariate Kaplan-Meier survival analysis. There was no significant relationship between AgNOR content and grade of malignancy, pT categories or pN categories. Multivariate survival analysis of covariates (Cox regression model) revealed a set of five variables that significantly influenced the patients' outcome: pN categories, AgNOR content, pT categories, maximum grade of malignancy and number of inflammatory cells. From the clinical and pathological parameters studied, pN and pT categories as well as the mean AgNOR number were the most important variables predicting death from colorectal carcinoma. Since the analysis of AgNORs can be performed on routinely processed paraffin-embedded tissue, this method may be of potential use in pretherapeutic assessment of the biologic aggressiveness of the disease.
Adenocarcinoma↗